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General NPI Number Information
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NPI Number | 1013732585
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Entity Type | Organization
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Legal Business Name | OMNI DYNAMICS
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 428 E PALMER ST
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City | DETROIT
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State | MI
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Zip | 48202-3826
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Country | US
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Telephone | 586-525-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 428 E PALMER ST
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City | DETROIT
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State | MI
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Zip | 48202-3826
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Country | US
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Telephone | 586-525-1220
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MS. AHMANI MICHELLE CUNNINGHAM
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Credential |
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Telephone | 586-525-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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